The Journal of bone and joint surgery. American volume
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Sixty-two Type-III open fractures of the tibial shaft are reported on. Eleven were Type IIIA, and three of them had non-union while none were associated with deep infection or required secondary amputation. ⋯ Unfortunately, of the nine Type-IIIC injuries, seven ultimately required secondary amputation, from two days to sixty-three months after the initial injury, because of pain, sepsis, non-union, or failure of the vascular repair. Only two patients who had a Type-IIIC fracture have avoided amputation to date, and their results were poor.
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Laterally comminuted fracture-dislocations of the ankle are highly unstable injuries in which anatomical reduction of the talus and restoration of fibular length and rotation are difficult. To our knowledge, no descriptions of the fracture pattern of these injuries and the surgical technique for treating them are available, and surgical results with this fracture have been disappointing. Discontinuity of the fibula as a result of comminution makes accurate assessment of fibular length and rotation impossible if the fibula is reduced first. ⋯ The fibular malleolus is then anatomically positioned in the lateral articular facet of the talus and fixed in this position. The osseous discontinuity of the fibula is grafted with bone. Clinical and radiographic results of the technique were highly satisfactory after a mean length of follow-up of thirty-four months.
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J Bone Joint Surg Am · Jun 1987
Comparative StudyStability of ten configurations of the Hoffmann external-fixation frame.
The rigidity, load to yield, and load to failure of ten configurations of the Hoffmann external fixator were investigated using a model of wooden pylons with a simulated fracture that consisted of either a reduced transverse cut or a ten-millimeter gap. The axial compressive, torsional, anterior-posterior bending, and medial-lateral bending characteristics of four forms of the single half-frame (half-pinned), four double half-frame, and two full-frame (transfixion-pinned) configurations were examined. Of the single half-frame configurations, a system with a second stacked connecting-rod proved to be superior; however, the system yielded at a mean axial compressive load of only 199 newtons and failed totally at 355 newtons. ⋯ The two full-frame systems performed poorly in torsion and particularly poorly in anterior-posterior bending. The loads that caused a one-millimeter movement within the fracture gap in axial compression were notably low: for the stacked half-frames the load did not exceed a mean value of 174 newtons; for the double half-frame, 190 newtons; and for the quadrilateral frame, 412 newtons. We concluded that no frame had a good over-all performance with regard to rigidity.(ABSTRACT TRUNCATED AT 250 WORDS)
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J Bone Joint Surg Am · Mar 1987
Open intramedullary nailing and bone-grafting for non-union of tibial diaphyseal fracture.
Twenty consecutive patients who had non-union of twenty-two fractures (two of the patients had a segmental fracture) of the tibia underwent open reduction, débridement, and intramedullary nailing that was supplemented by bone-grafting with either autogenous cancellous iliac bone or cortical reamings of bone from the intramedullary canal. Eighteen patients had significant deformity associated with the tibial fracture. All but three patients had postoperative splinting for two to four weeks, followed by walking without a brace; the three patients who did not have postoperative splinting were more than sixty-five years old. ⋯ Two patients had a minor complication that did not affect the final result. Incorporation of callus across the site of non-union occurred at a rapid rate. Anatomical alignment of the tibial shaft was obtained in nineteen of the twenty patients.